Microbiological, Epidemiological, and Clinical Characteristics and Outcomes of Patients with Cryptococcosis in Taiwan, 1997–2010

Abstract

BackgroundAmong members of Cryptococcus neoformans- Cryptococcus gattii species complex, C. neoformans is distributed worldwide whereas C. gattii is considered to be more prevalent in the subtropics and tropics including Taiwan. This nationwide study was undertaken to determine the distribution of genotypes, clinical characteristics and outcomes of 219 patients with proven cryptococcosis at 20 hospitals representative of all geographic areas in Taiwan during 1997–2010.Methods and FindingsOf 219 isolates analyzed, C. neoformans accounted for 210 isolates (95.9%); nine isolates were C. gattii (4.1%). The predominant genotype was VNI (206 isolates). The other genotypes included VNII (4 isolates), VGI (3 isolates) and VGII (6 isolates). Antifungal minimal inhibition concentrations higher than epidemiologic cutoff values (ECVs) were found in nine VNI isolates (7 for amphotericin B). HIV infection was the most common underlying condition (54/219, 24.6%). Among HIV-negative patients, liver diseases (HBV carrier or cirrhosis) were common (30.2%) and 15.4% did not have any underlying condition. Meningoencephalitis was the most common presentation (58.9%), followed by pulmonary infection (19.6%) and “others” (predominantly cryptococcemia) (18.7%). The independent risk factors for 10-week mortality, by multivariate analysis, were cirrhosis of liver (P = 0.014) and CSF cryptococcal antigen titer ≥512 (P = 0.020). All except one of 54 HIV-infected patients were infected by VNI genotype (98.1%). Of the 13 isolates of genotypes other than VNI, 12 (92.3%) were isolated from HIV-negative patients. HIV-infected patients compared to HIV-negative patients were more likely to have meningoencephalitis and serum cryptococcal antigen ≥1∶512. Patients infected with C. gattii compared to C. neoformans were younger, more likely to have meningoencephalitis (100% vs. 57%), reside in Central Taiwan (56% vs. 31%), and higher 10-week crude mortality (44.4% vs. 22.2%).ConclusionsCryptococcus neoformans in Taiwan, more prevalent than C. gatii, has a predominant VNI genotype. Isolates with antifungal MIC higher than ECVs were rare.

Molecular epidemiology of Cryptococcus neoformans and Cryptococcus gattii in China between 2007 and 2013 using multilocus sequence typing and the DiversiLab system

“…A strain of C. gattii VGII (PU8) from the temperate climate region located on longitude 115°~116°and latitude 37°~38°in China was detected in our study. Few VGII isolates had been reported in China previously, all of which were distributed in the subtropical climate zones of South China [18,38]. Our VGII (ST=182) strain was different from XH91 reported as VGII in China in 2008 [18].…”

Disseminated Cryptococcal Infection Resulting in Acute Respiratory Distress Syndrome (ARDS) as the Initial Clinical Presentation of AIDS

“…On day 2 of admission, his clinical course was complicated by the worsening of his tachypnea and hypoxemia, which required endotracheal intubation and mechanical ventilation. A transthoracic echocardiogram revealed a left ventricular ejection fraction of 15% (55-65), without segmental wall motion abnormalities, and a systolic pulmonary artery pressure of 49 mmHg (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). These results were unchanged from a previous echocardiogram, which was obtained a few months prior to admission.…”

“…Blood cultures are positive in >50% of patients with disseminated cryptococcal disease (4, 23,25). Serum samples are usually positive for cryptococcal antigen, with markedly elevated titers in patients with cryptococcal pneumonia (4, [25][26][27]. Respiratory failure in patients with cryptococcosis seems to be multifactorial.…”

Refractory and/or Relapsing Cryptococcosis Associated with Acquired Immune Deficiency Syndrome: Clinical Features, Genotype, and Virulence Factors of Cryptococcus spp. Isolates

“…Chronic liver disease and leucopenia predominated in the cases of refractory and/or recurrent cryptococcosis. Cirrhosis was related to a greater lethality of cryptococcosis within 10 weeks 31 and may have increased the severity of infection by reducing the hepatic clearance of yeast cells and their antigen. Neutropenia can be a complication of the treatment of cryptococcosis, especially in patients with AIDS receiving flucytosine.…”